EP0615724A2 - Surgical suturing clamp particularly for purse string sutures - Google Patents

Surgical suturing clamp particularly for purse string sutures Download PDF

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Publication number
EP0615724A2
EP0615724A2 EP94102366A EP94102366A EP0615724A2 EP 0615724 A2 EP0615724 A2 EP 0615724A2 EP 94102366 A EP94102366 A EP 94102366A EP 94102366 A EP94102366 A EP 94102366A EP 0615724 A2 EP0615724 A2 EP 0615724A2
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EP
European Patent Office
Prior art keywords
clamp
seam
jaws
push rod
clamp according
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
EP94102366A
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German (de)
French (fr)
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EP0615724B1 (en
EP0615724A3 (en
Inventor
Ferdinand Dr. Köckerling
Ignaz Dr. Schneider
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Individual
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Individual
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1142—Purse-string sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws

Definitions

  • the invention relates to a surgical suture clamp, in particular a tobacco pouch suture clamp for laying a tobacco pouch suture in gastric, intestinal, lung operations or the like, with two clamp jaws which are mounted such that they can move relative to one another in the manner of pliers.
  • the invention has for its object to provide a surgical suture clip, and in particular tobacco pouch suture clip, of the generic type that can be used in the context of endoscopic surgery.
  • the seam clamp is designed as an endoscopic seam clamp that can be inserted into the interior of the body through a trocar, with an insertion tube, in the area of which the inner tube end, which can be inserted into the interior of the body, has at least one clamp jaw pivotably driven relative to the second clamp jaw.
  • a drive is arranged in the region of the outer tube end remaining outside the body, which drive is connected to the at least one gear a pivotally driven clamping jaw is coupled.
  • the suture clamp in the context of endoscopic surgery, it being understood that the tube and in particular the clamp jaws arranged on the inner tube end are arranged and dimensioned, at least in the closed state, in such a way that these parts can be passed through the inner opening of the Trokars fit and can thus serve as a lock in the abdominal wall for the suture clip.
  • the clamping jaws of the endoscopic suture clamp are arranged with their longitudinal direction at a small acute angle to the longitudinal axis of the insertion tube. This inclined position on the one hand ensures that a needle channel formed in the clamping jaws is easily accessible from both ends of the clamping jaws. On the other hand, the clamp jaws remain in the closed state with respect to the longitudinal axis of the insertion tube within its outline, so that the seam clamp can also be pushed through the inner opening of the trocar with the inclined clamp jaws.
  • An endoscopic tobacco pouch suture clamp according to the invention has as its main component an insertion tube 1 which can be inserted into the inside of the body through a trocar (not shown) in the abdominal wall of the patient.
  • a trocar not shown
  • two clamp jaws 3, 4 are pivotably driven, both clamp jaws 3, 4 being designed as arms of a double-armed clamp lever 5, 6.
  • the latter are pivotally mounted between the fork legs 7, 8 of a fork-shaped bearing head 9 fastened to the inner tube end 2 by means of a common pivot axis 10.
  • the mutually facing clamping surfaces 11, 12 of the two clamping jaws 3, 4 are each designed in a wave-like manner in the customary manner, the elevations 13 in the clamping surfaces 11, 12 each being shown by a broken line in the longitudinal direction L of the clamping jaws 3 in FIGS. 1 and 2, 4 extending needle channel 14 are penetrated. A thread is pulled through these needle channels 14 with the aid of needles in the closed state of the clamp in the same direction for laying the tobacco pouch seam.
  • the two clamping jaws 3, 4 run in the closed state (Fig. 1,2) with their longitudinal direction L at a small acute angle W to the longitudinal axis A of the insertion tube 1.
  • This angle W is about 10 ° and is dimensioned so that the Clamping jaws 3, 4 in the closed position (FIG. 1, 2) lie within the circular outline of the insertion tube 1 in relation to a viewing direction of the clamping jaws 3, 4 running parallel to the longitudinal axis A of the tube 1.
  • the orifices of the needle channel 14 are easily accessible, which has a particularly favorable effect when needles are inserted into the needle channel 14 with the aid of an endoscopic manipulator.
  • a substantially cylindrical grip piece coaxially 16 screwed on by means of the screw connection 17, the handle 16 having a continuous inner bore 19 running coaxially with the pipe opening 18.
  • a coaxial ring shoulder 21 on which a spindle wheel 22 with its cylindrical inner opening 23 is rotatably mounted.
  • a circumferential groove 24 is also provided, into which grub screws 25 engage as projections from the outside.
  • the external thread 32 of the threaded bolt 31 is in engagement with the internal thread 30 in the spindle wheel 22.
  • the threaded bolt 31 is connected at its end 33 facing away from the spindle wheel 22 to a push rod 34 which leads to the fork-shaped bearing head 9 and ends there within the two fork legs 7, 8.
  • two toggle links 36, 37 are articulated at the ends by means of a common joint axis 38.
  • the two other ends of the toggle links 36, 37 are each articulated to the two actuating arms 39, 40 of the clamp levers 5, 6 via articulated axes 41, 42. Due to the construction described above, the threaded bolt 31 together with the push rod 34 and the two toggle lever cores 36, 37 form a transmission for transmitting the rotary drive movement originating from the spindle wheel 22 to the two clamp levers 5, 6.
  • the unit consisting of threaded bolt 31 and push rod 34 is also locked in the direction of rotation.
  • the threaded bolt 31 is on the outside with a radially protruding elevation in In the form of a screw head 43 of a screw radially screwed into the threaded bolt, which screw head 43 engages in an elongated hole 44 running therein parallel to the longitudinal axis A of the insertion tube 1.
  • the clamping jaws 3, 4 are opened and closed as follows:
  • the spindle wheel 22 is rotatably actuated .
  • the rotational locking of the threaded bolt 31 and the push rod 34 converts the rotary movement of the spindle wheel 22 in the manner of a spindle drive into a pushing movement of the threaded bolt 31 and push rod 34 in the direction of the inner tube end 2 of the insertion tube 1.
  • the spindle wheel 22 is actuated in the opposite direction of rotation, as a result of which the threaded bolt 31 with the push rod 34 is displaced in the opposite direction coaxially to the longitudinal axis A and the two clamping levers 5, 6 are retracted again via the toggle link 36.37 .

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Materials For Medical Uses (AREA)

Abstract

A surgical suturing clamp is provided with two clamping jaws (3, 4) which can be moved relative to one another in a forceps-like manner. It is designed as a suturing clamp which can be used with an endoscope, can be inserted through a trocar into the interior of the body and has an insertion pipe (1). In the region of the latter's inner pipe end (2) which can be inserted in the interior of the body at least one clamping jaw (3) is mounted so as to be actuated pivotably relative to the second clamping jaw (4). In the region of the outer pipe end (15) remaining outside the body there is arranged a drive (spindle wheel 22) which is coupled via a gear (threaded bolt 31, connecting rod 34) to the at least one, pivotably driven clamping jaw (3). <IMAGE>

Description

Die Erfindung betrifft eine chirurgische Nahtklemme, insbesondere eine Tabaksbeutel-Nahtklemme zum Legen einer Tabaksbeutel-Naht bei Magen-, Darm-, Lungen-Operationen oder dergleichen, mit zwei zangenartig relativ zueinander beweglich gelagerten Klemmerbacken.The invention relates to a surgical suture clamp, in particular a tobacco pouch suture clamp for laying a tobacco pouch suture in gastric, intestinal, lung operations or the like, with two clamp jaws which are mounted such that they can move relative to one another in the manner of pliers.

Zum Legen einer Tabaksbeutel-Naht mit Hilfe der eingangs genannten Nahtklemme z.B. zum Verschließen des Dickdarms bei bestimmten Darmoperationen, wie Darm-Teilentfernungen, ist bisher ein üblicher, relativ langer Operationsschnitt in der Bauchdecke notwendig.Bisher konnte nämlich eine derartige Naht aufgrund der scherenartigen Ausbildung der Nahtklemme nicht im Rahmen der sogenannten endoskopischen Chirurgie gelegt werden, bei der die notwendigen Beobachtungsinstrumente, wie Endoskope, und chirurgischen Instrumente über die Bauchdecke durchstoßende Trokare eingeführt werden. Insofern waren bestimmte Operationen, bei denen z.B. eine Tabaksbeutel-Naht gelegt werden muß, nicht mit den Mitteln der endoskopischen Chirurgie durchführbar.To lay a tobacco pouch seam with the help of the seam clamp mentioned above, e.g. To close the colon during certain intestinal operations, such as partial removal of the intestine, a conventional, relatively long surgical incision in the abdominal wall has so far been necessary, because such a suture could not be made in the context of so-called endoscopic surgery due to the scissors-like design of the suture clamp the necessary observation instruments, such as endoscopes, and surgical instruments are introduced through trocars penetrating the abdominal wall. In this respect, certain operations, e.g. a tobacco pouch suture must be placed, not feasible with endoscopic surgery.

Ausgehend von dieser Problematik liegt der Erfindung die Aufgabe zugrunde, eine chirurgische Nahtklemme, und insbesondere Tabaksbeutel-Nahtklemme, der gattungsgemäßen Art anzugeben, die im Rahmen der endoskopischen Chirurgie anwendbar ist.Based on this problem, the invention has for its object to provide a surgical suture clip, and in particular tobacco pouch suture clip, of the generic type that can be used in the context of endoscopic surgery.

Diese Aufgabe wird durch die im Kennzeichnungsteil des Anspruches 1 angegebenen Merkmale gelöst. Demnach ist die Nahtklemme als endoskopierbare, durch ein Trokar in das Körperinnere einführbare Nahtklemme mit einem Einführungsrohr ausgebildet, im Bereich dessen in das Körperinnere einführbaren, inneren Rohrendes mindestens ein Klemmenbacken relativ zum zweiten Klemmenbacken schwenkbar angetrieben gelagert ist. Darüber hinaus ist im Bereich des außerhalb des Körpers verbleibenden, äußeren Rohrendes ein Antrieb angeordnet, der über ein Getriebe mit dem mindestens einen schwenkbar angetriebenen Klemmenbacken gekoppelt ist.This object is achieved by the features specified in the characterizing part of claim 1. Accordingly, the seam clamp is designed as an endoscopic seam clamp that can be inserted into the interior of the body through a trocar, with an insertion tube, in the area of which the inner tube end, which can be inserted into the interior of the body, has at least one clamp jaw pivotably driven relative to the second clamp jaw. In addition, a drive is arranged in the region of the outer tube end remaining outside the body, which drive is connected to the at least one gear a pivotally driven clamping jaw is coupled.

Aufgrund dieser Ausgestaltung ist es möglich, die Nahtklemme im Rahmen der endoskopischen Chirurgie zu verwenden, wobei es sich versteht, daß das Rohr sowie insbesondere die am inneren Rohrende angeordneten Klemmenbacken zumindest im geschlossenen Zustand so angeordnet und dimensioniert sind, daß diese Teile durch die Innenöffnung des Trokars passen und dieser somit als Schleuse in der Bauchdecke für die Nahtklemme dienen kann.Because of this configuration, it is possible to use the suture clamp in the context of endoscopic surgery, it being understood that the tube and in particular the clamp jaws arranged on the inner tube end are arranged and dimensioned, at least in the closed state, in such a way that these parts can be passed through the inner opening of the Trokars fit and can thus serve as a lock in the abdominal wall for the suture clip.

In einer bevorzugten Ausführungsform sind die Klemmenbacken der endoskopischen Nahtklemme mit ihrer Längsrichtung in einem kleinen spitzen Winkel zur Langsachse des Einführungsrohres angeordnet. Durch diese Schrägstellung wird einerseits erreicht, daß ein in den Klemmenbacken ausgebildeter Nadelkanal von beiden Enden der Klemmenbacken her gut zugänglich ist. Andererseits verbleiben dadurch die Klemmenbacken im geschlossenen Zustand bezogen auf die Längsachse des Einführungsrohres innerhalb dessen Umrisses, so daß die Nahtklemme auch mit den schräggestellten Klemmenbacken durch die Innenöffnung des Trokars geschoben werden kann.In a preferred embodiment, the clamping jaws of the endoscopic suture clamp are arranged with their longitudinal direction at a small acute angle to the longitudinal axis of the insertion tube. This inclined position on the one hand ensures that a needle channel formed in the clamping jaws is easily accessible from both ends of the clamping jaws. On the other hand, the clamp jaws remain in the closed state with respect to the longitudinal axis of the insertion tube within its outline, so that the seam clamp can also be pushed through the inner opening of the trocar with the inclined clamp jaws.

Weitere Merkmale, Einzelheiten und Vorteile der Erfindung sind den Unteransprüchen und der nachfolgenden Beschreibung entnehmbar, in der ein Ausführungsbeispiel des Erfindungsgegenstandes anhand der beiliegenden Figuren näher erläutert wird. Es zeigen:

Fig. 1
eine Seitenansicht einer erfindungsgemäßen Tabaksbeutel-Nahtklemme,
Fig. 2
eine Seitenansicht der Klemme aus Pfeilrichtung II gem. Fig. 1 in geschlossenem Zustand der Klemmenbacken und
Fig. 3
eine teilweise entlang der Schnittlinie III-III nach Fig. 1 geschnittene Seitenansicht der Klemme aus Pfeilrichtung II mit geöffneten Klemmenbacken.
Further features, details and advantages of the invention can be found in the subclaims and the following description, in which an embodiment of the subject of the invention is explained in more detail with reference to the accompanying figures. Show it:
Fig. 1
a side view of a tobacco pouch seam clamp according to the invention,
Fig. 2
a side view of the clamp from arrow direction II acc. Fig. 1 in the closed state of the jaws and
Fig. 3
a partially cut along the section line III-III of FIG. 1 side view of the clamp from the direction of arrow II with open jaws.

Eine erfindungsgemäße endoskopische Tabaksbeutel-Nahtklemme, wie sie in den Fig. 1 bis 3 dargestellt ist, weist als Hauptbestandteil ein Einführungsrohr 1 auf, das durch ein (nicht dargestelltes) Trokar in der Bauchdecke des Patienten in das Körperinnere einführbar ist. Im Bereich des in das Körperinnere einführbaren, inneren Rohrendes 2 sind zwei Klemmenbacken 3,4 schwenkbar angetrieben gelagert, wobei beide Klemmenbacken 3,4 jeweils als Arm eines doppelarmigen Klemmenhebels 5,6 ausgebildet sind. Letztere sind zwischen den Gabelschenkeln 7,8 eines am inneren Rohrende 2 befestigten, gabelförmigen Lagerkopfes 9 mittels einer gemeinsamen Schwenkachse 10 schwenkbar gelagert.An endoscopic tobacco pouch suture clamp according to the invention, as shown in FIGS. 1 to 3, has as its main component an insertion tube 1 which can be inserted into the inside of the body through a trocar (not shown) in the abdominal wall of the patient. In the area of the inner tube end 2, which can be inserted into the interior of the body, two clamp jaws 3, 4 are pivotably driven, both clamp jaws 3, 4 being designed as arms of a double-armed clamp lever 5, 6. The latter are pivotally mounted between the fork legs 7, 8 of a fork-shaped bearing head 9 fastened to the inner tube end 2 by means of a common pivot axis 10.

Die einander zugewandten Klemmflächen 11,12 der beiden Klemmenbacken 3,4 sind in üblicher Weise jeweils wellenförmig ausgestaltet, wobei die Erhebungen 13 in den Klemmflächen 11,12 jeweils durch einen in Fig. 1 und 2 strichliert dargestellten, in Längsrichtung L der Klemmenbacken 3,4 verlaufenden Nadelkanal 14 durchsetzt sind. Durch diese Nadelkanäle 14 wird mit Hilfe von Nadeln im geschlossenen Zustand der Klemme ein Faden in gleichläufiger Richtung zum Legen der Tabaksbeutel-Naht hindurchgezogen.The mutually facing clamping surfaces 11, 12 of the two clamping jaws 3, 4 are each designed in a wave-like manner in the customary manner, the elevations 13 in the clamping surfaces 11, 12 each being shown by a broken line in the longitudinal direction L of the clamping jaws 3 in FIGS. 1 and 2, 4 extending needle channel 14 are penetrated. A thread is pulled through these needle channels 14 with the aid of needles in the closed state of the clamp in the same direction for laying the tobacco pouch seam.

Die beiden Klemmenbacken 3,4 verlaufen im übrigen in geschlossenem Zustand (Fig. 1,2) mit ihrer Längsrichtung L in einem kleinen spitzen Winkel W zur Längsachse A des Einführungsrohres 1. Dieser Winkel W beträgt etwa 10° und ist so bemessen, daß die Klemmenbacken 3,4 in Schließstellung (Fig. 1,2) innerhalb des kreisförmigen Umrisses des Einführungsrohres 1 bezogen auf eine parallel zur Längsachse A des Rohres 1 verlaufende Betrachtungsrichtung der Klemmbacken 3,4 liegen. Durch diese Schrägstellung sind die Mündungsöffnungen des Nadelkanals 14 bequem zugänglich, was sich bei der Einführung von Nadeln in den Nadelkanal 14 mit Hilfe eines endoskopischen Manipulators besonders günstig auswirkt.The two clamping jaws 3, 4 run in the closed state (Fig. 1,2) with their longitudinal direction L at a small acute angle W to the longitudinal axis A of the insertion tube 1. This angle W is about 10 ° and is dimensioned so that the Clamping jaws 3, 4 in the closed position (FIG. 1, 2) lie within the circular outline of the insertion tube 1 in relation to a viewing direction of the clamping jaws 3, 4 running parallel to the longitudinal axis A of the tube 1. As a result of this inclination, the orifices of the needle channel 14 are easily accessible, which has a particularly favorable effect when needles are inserted into the needle channel 14 with the aid of an endoscopic manipulator.

Auf das außerhalb des Körpers verbleibende, äußere Rohrende 15 des Einführungsrohres 1 ist koaxial ein im wesentlichen zylindrisches Griffstück 16 mittels der Schraubverbindung 17 aufgeschraubt, wobei das Griffstück 16 eine koaxial mit der Rohröffnung 18 verlaufende, durchgehende Innenbohrung 19 aufweist. An dem dem Einführungsrohr 1 abgewandten Stirnende 20 des Griffstückes 16 ist eine ebenfalls koaxial verlaufende Ringschulter 21 vorgesehen, auf der ein Spindelrad 22 mit seiner zylindrischen Innenöffnung 23 drehbar gelagert ist. Am äußeren Umfang der Ringschulter 21 ist ferner eine Umfangsnut 24 vorgesehen, in die von außen Madenschrauben 25 als Vorsprünge eingreifen. Diese Madenschrauben sind durch entsprechende Gewindebohrungen 26 in dem Ringkragen 27 um die zylindrische Innenöffnung 23 des Spindelrades 22 hindurchgeschraubt und legen letzteres in längsaxialer Richtung des Einführungsrohres 1 fest. Zwischen der Stirnseite des Ringkragens 27 und dem Griffstück 16 ist ein Gleitring 28 aus Messing eingesetzt.On the outer tube end 15 of the insertion tube 1 remaining outside the body, there is a substantially cylindrical grip piece coaxially 16 screwed on by means of the screw connection 17, the handle 16 having a continuous inner bore 19 running coaxially with the pipe opening 18. At the end 20 of the handle 16 facing away from the insertion tube 1 there is also a coaxial ring shoulder 21 on which a spindle wheel 22 with its cylindrical inner opening 23 is rotatably mounted. On the outer circumference of the annular shoulder 21, a circumferential groove 24 is also provided, into which grub screws 25 engage as projections from the outside. These grub screws are screwed through corresponding threaded bores 26 in the annular collar 27 around the cylindrical inner opening 23 of the spindle wheel 22 and fix the latter in the longitudinal axial direction of the insertion tube 1. A slide ring 28 made of brass is inserted between the end face of the ring collar 27 and the handle 16.

Das Spindelrad 22 bildet mit seiner koaxial zur Längsachse A des Einführungsrohres 1 angeordneten, von der Innenöffnung 23 ausgehenden Sacklochbohrung 29 mit Innengewinde 30 zusammen mit einem Gewindebolzen 31 in der Innenbohrung 19 des Griffstückes 16 einen Spindeltrieb für die Klemmenbacken 3,4. Dazu steht das Außengewinde 32 des Gewindebolzens 31 mit dem Innengewinde 30 im Spindelrad 22 in Eingriff. Weiterhin ist der Gewindebolzen 31 an seinem dem Spindelrad 22 abgewandten Ende 33 mit einer Schubstange 34 verbunden, die zum gabelförmigen Lagerkopf 9 führt und dort innerhalb der beiden Gabelschenkel 7,8 endet. An diesem entsprechenden Ende 35 der Schubstange 34 sind zwei Kniehebellenker 36, 37 mittels einer gemeinsamen Gelenkachse 38 endseitig angelenkt. Die beiden anderen Enden der Kniehebellenker 36,37 sind jeweils gelenkig mit den beiden Betätigungsarmen 39,40 der Klemmenhebel 5,6 über Gelenkachsen 41,42 verbunden. Aufgrund der vorstehend beschriebenen Konstruktion bilden der Gewindebolzen 31 gemeinsam mit der Schubstange 34 und den beiden Kniehebellenkern 36,37 ein Getriebe zur Übertragung der vom Spindelrad 22 herrührenden Drehantriebsbewegung auf die beiden Klemmenhebel 5,6. Dabei ist ferner die Einheit aus Gewindebolzen 31 und Schubstange 34 in Drehrichtung arretiert. Für diese Dreharretierung ist der Gewindebolzen 31 auf seiner Außenseite mit einer radial abstehenden Erhebung in Form eines Schraubenkopfes 43 einer radial in den Gewindebolzen eingeschraubten Schraube versehen, welcher Schraubenkopf 43 in ein parallel zur Längsachse A des Einführungsrohres 1 darin verlaufendes Langloch 44 eingreift.The spindle wheel 22, with its blind hole 29 with internal thread 30 arranged coaxially to the longitudinal axis A of the insertion tube 1 and starting from the inner opening 23, together with a threaded bolt 31 in the inner bore 19 of the handle 16, forms a spindle drive for the clamping jaws 3, 4. For this purpose, the external thread 32 of the threaded bolt 31 is in engagement with the internal thread 30 in the spindle wheel 22. Furthermore, the threaded bolt 31 is connected at its end 33 facing away from the spindle wheel 22 to a push rod 34 which leads to the fork-shaped bearing head 9 and ends there within the two fork legs 7, 8. At this corresponding end 35 of the push rod 34, two toggle links 36, 37 are articulated at the ends by means of a common joint axis 38. The two other ends of the toggle links 36, 37 are each articulated to the two actuating arms 39, 40 of the clamp levers 5, 6 via articulated axes 41, 42. Due to the construction described above, the threaded bolt 31 together with the push rod 34 and the two toggle lever cores 36, 37 form a transmission for transmitting the rotary drive movement originating from the spindle wheel 22 to the two clamp levers 5, 6. The unit consisting of threaded bolt 31 and push rod 34 is also locked in the direction of rotation. For this rotation lock, the threaded bolt 31 is on the outside with a radially protruding elevation in In the form of a screw head 43 of a screw radially screwed into the threaded bolt, which screw head 43 engages in an elongated hole 44 running therein parallel to the longitudinal axis A of the insertion tube 1.

Das Öffnen und Schließen der Klemmenbacken 3,4 geschieht wie folgt:The clamping jaws 3, 4 are opened and closed as follows:

Ausgehend von der in den Fig. 1 und 2 gezeigten Schließstellung der beiden Klemmenbacken 3,4, in der die Kniehebellenker 36,37 und die Betätigungsarme 39,40 innerhalb der beiden Gabelschenkel 7,8 des gabelförmigen Lagerkopfes 9 liegen, wird das Spindelrad 22 drehbetätigt. Durch die Dreharretierung von Gewindebolzen 31 und Schubstange 34 wird die Drehbewegung des Spindelrades 22 nach Art eines Spindeltriebes in eine Schubbewegung von Gewindebolzen 31 und Schubstange 34 in Richtung zum inneren Rohrende 2 des Einführungsrohres 1 umgesetzt. Aufgrund dieser Schubbewegung und der Annäherung der Gelenkachse 38 an die Schwenkachse 10 der beiden Klemmenhebel 5,6 spreizen sich die beiden Kniehebellenker 36,37 nach außen auf und spreizen demzufolge die beiden Betätigungsarme 39,40 der Klemmenhebel 5,6 (Fig. 3). Die Klemmenbacken 3,4 werden damit in ihre Öffnungsstellung übergeführt.Starting from the closed position of the two clamping jaws 3, 4 shown in FIGS. 1 and 2, in which the toggle links 36, 37 and the actuating arms 39, 40 lie within the two fork legs 7, 8 of the fork-shaped bearing head 9, the spindle wheel 22 is rotatably actuated . The rotational locking of the threaded bolt 31 and the push rod 34 converts the rotary movement of the spindle wheel 22 in the manner of a spindle drive into a pushing movement of the threaded bolt 31 and push rod 34 in the direction of the inner tube end 2 of the insertion tube 1. Due to this pushing movement and the approach of the hinge axis 38 to the pivot axis 10 of the two clamp levers 5, 6, the two toggle links 36, 37 spread outwards and consequently spread the two actuating arms 39, 40 of the clamp levers 5, 6 (FIG. 3). The clamping jaws 3, 4 are thus brought into their open position.

Zum Schließen der Klemmenbacken 3,4 wird das Spindelrad 22 in entgegengesetzter Drehrichtung betätigt, wodurch der Gewindebolzen 31 mit der Schubstange 34 in die entgegengesetzte Richtung koaxial zur Längsachse A verschoben und damit die beiden Klemmenhebel 5,6 über die Kniehebellenker 36,37 wieder eingezogen werden.To close the clamping jaws 3, 4, the spindle wheel 22 is actuated in the opposite direction of rotation, as a result of which the threaded bolt 31 with the push rod 34 is displaced in the opposite direction coaxially to the longitudinal axis A and the two clamping levers 5, 6 are retracted again via the toggle link 36.37 .

Claims (9)

Chirurgische Nahtklemme, insbesondere Tabaksbeutel-Nahtklemme zum Legen einer Tabaksbeutel-Naht bei Magen-, Darm-, Lungenoperationen oder dergleichen, mit zwei zangenartig relativ zueinander beweglich gelagerten Klemmenbacken (3,4), dadurch gekennzeichnet, daß die Nahtklemme als endoskopierbare, durch ein Trokar in das Körperinnere einführbare Nahtklemme mit einem Einführungsrohr (1) ausgebildet ist, im Bereich dessen in das Körperinnere einführbaren, inneren Rohrendes (2) mindestens ein Klemmenbacken (3) relativ zum zweiten Klemmenbacken (4) schwenkbar angetrieben gelagert ist und daß im Bereich des außerhalb des Körpers verbleibenden, äußeren Rohrendes (15) ein Antrieb (Spindelrad 22) angeordnet ist, der über ein Getriebe (Gewindebolzen 31, Schubstange 34) mit dem mindestens einen schwenkbar angetriebenen Klemmenbacken (3,4) zum Öffnen und Schließen der Nahtklemme gekoppelt ist.Surgical suture clamp, in particular tobacco pouch suture clamp for laying a tobacco pouch suture in gastric, intestinal, lung operations or the like, with two clamp jaws (3, 4) which are mounted such that they can move relative to one another in pliers, characterized in that the suture clamp is endoscopic, by means of a trocar into the body insertable seam clamp is formed with an insertion tube (1), in the area of the inner tube end insertable into the inner tube end (2) at least one clamp jaw (3) is pivotally driven relative to the second clamp jaw (4) and that in the area of the outside of the body remaining outer tube end (15), a drive (spindle wheel 22) is arranged, which is coupled via a gear (threaded bolt 31, push rod 34) to the at least one pivotally driven clamping jaws (3, 4) for opening and closing the seam clamp. Nahtklemme nach Anspruch 1, dadurch gekennzeichnet, daß Antrieb und Getriebe als Spindeltrieb mit einem längsaxial bezüglich der Rohrachse (Längsachse A) festgelegten, koaxial dazu drehbar gelagerten Spindelrad (22) und einer in Drehrichtung arretierten, längsaxial im Einführungsrohr (1) verschiebbaren Schubstange (34, Gewindebolzen 31) ausgebildet sind, die mit einem Außengewinde (32) an ihrem äußeren Ende mit einem Innengewinde (30) des Spindelrades (22) in Eingriff steht und die mit ihrem inneren Ende (35) mit dem mindestens einen schwenkbar gelagerten Klemmenbacken (3,4) gelenkig gekoppelt ist.Seam clamp according to claim 1, characterized in that the drive and gear as a spindle drive with a spindle wheel (22) fixed axially axially with respect to the tube axis (longitudinal axis A) and rotatably mounted coaxially therewith and a push rod (34) locked in the direction of rotation and displaceable longitudinally in the insertion tube (1) , Threaded bolts 31) are formed which engage with an external thread (32) at their outer end with an internal thread (30) of the spindle wheel (22) and which with their inner end (35) with the at least one pivotally mounted clamping jaw (3 , 4) is articulated. Nahtklemme nach Anspruch 2, dadurch gekennzeichnet, daß beide Klemmenbacken (3,4) jeweils als Arm doppelarmiger Klemmenhebel (5,6) ausgebildet sind, die um eine Achse (Schwenkachse 10) am inneren Rohrende (2) schwenkbar gelagert sind und deren Betätigungsarme (39,40) jeweils über Kniehebellenker (36,37) gelenkig mit dem inneren Ende (35) der Schubstange (34) verbunden sind.Seam clamp according to claim 2, characterized in that both clamp jaws (3, 4) are each designed as arms with double-armed clamp levers (5, 6) which are pivotably mounted about an axis (pivot axis 10) on the inner tube end (2) and whose actuating arms ( 39, 40) are each articulated to the inner end (35) of the push rod (34) via toggle links (36, 37). Nahtklemme nach Anspruch 3, dadurch gekennzeichnet, daß am inneren Rohrende (2) ein gabelförmiger Lagerkopf (9) vorgesehen ist, zwischen dessen Gabelschenkel (7,8) die Klemmenhebel (5,6) um eine gemeinsame Achse (Schwenkachse 10) schwenkbar gelagert sind.Seam clamp according to claim 3, characterized in that a fork-shaped bearing head (9) is provided on the inner tube end (2) between the fork legs (7,8) the clamp levers (5,6) are pivotally mounted about a common axis (pivot axis 10). Nahtklemme nach Anspruch 4, dadurch gekennzeichnet, daß das innere Ende (35) der Schubstange (34) und die Kniehebellenker (36,37) zumindest bei geschlossenen Klemmenbacken (3,4) zwischen den Gabelschenkels (7,8) des gabelförmigen Lägerkopfes (9) angeordnet sind.Seam clamp according to claim 4, characterized in that the inner end (35) of the push rod (34) and the toggle link (36, 37) at least when the clamp jaws (3, 4) are closed between the fork legs (7, 8) of the fork-shaped bearing head (9 ) are arranged. Nahtklemme nach einem der Ansprüche 1 bis 5, dadurch gekennzeichnet, daß die Klemmenbacken (3,4) mit ihrer Längsrichtung (L) in einem kleinen spitzen Winkel (W) zur Längsachse (A) des Einführungsrohres (1) verlaufen.Seam clamp according to one of claims 1 to 5, characterized in that the clamp jaws (3, 4) run with their longitudinal direction (L) at a small acute angle (W) to the longitudinal axis (A) of the insertion tube (1). Nahtklemme nach einem der Ansprüche 1 bis 6, dadurch gekennzeichnet, daß am äußeren Rohrende (15) ein im wesentlichen zylindrisches Griffstück (16) angeordnet ist.Seam clamp according to one of claims 1 to 6, characterized in that an essentially cylindrical handle (16) is arranged on the outer tube end (15). Nahtklemme nach Anspruch 7, dadurch gekennzeichnet, daß das Spindelrad (22) am Griffstück (16) drehbar gelagert und mittels in eine ringförmige Umfangsnut (24) am Griffstück (16) eingreifender Vorsprünge (25) am Spindelrad (22) längsaxial festgelegt ist.Seam clamp according to claim 7, characterized in that the spindle wheel (22) is rotatably mounted on the handle (16) and is axially fixed on the spindle wheel (22) by means of projections (25) which engage in an annular circumferential groove (24) on the handle (16). Nahtklemme nach einem der Ansprüche 1 bis 8, dadurch gekennzeichnet, daß zur Dreharretierung der Schubstange (34, Gewindebolzen 31) diese mit einer radial abstehenden Erhebung (Schraubenkopf 43) versehen ist, die in ein parallel zur Längsachse (A) des Einführungsrohres (1) verlaufendes Langloch (44) eingreift.Seam clamp according to one of claims 1 to 8, characterized in that for the rotational locking of the push rod (34, threaded bolt 31) it is provided with a radially protruding elevation (screw head 43) which is parallel to the longitudinal axis (A) of the insertion tube (1) running slot (44) engages.
EP94102366A 1993-03-17 1994-02-17 Surgical suturing clamp particularly for purse string sutures Expired - Lifetime EP0615724B1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE4308454 1993-03-17
DE4308454A DE4308454A1 (en) 1993-03-17 1993-03-17 Surgical suture clip, in particular tobacco pouch suture clip

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EP0615724A2 true EP0615724A2 (en) 1994-09-21
EP0615724A3 EP0615724A3 (en) 1995-02-15
EP0615724B1 EP0615724B1 (en) 1998-06-10

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EP94102366A Expired - Lifetime EP0615724B1 (en) 1993-03-17 1994-02-17 Surgical suturing clamp particularly for purse string sutures

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US (1) US5474570A (en)
EP (1) EP0615724B1 (en)
JP (1) JPH06296616A (en)
AT (1) ATE167036T1 (en)
DE (2) DE4308454A1 (en)

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Also Published As

Publication number Publication date
US5474570A (en) 1995-12-12
EP0615724B1 (en) 1998-06-10
ATE167036T1 (en) 1998-06-15
JPH06296616A (en) 1994-10-25
DE59406160D1 (en) 1998-07-16
EP0615724A3 (en) 1995-02-15
DE4308454A1 (en) 1994-09-22

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